Clinical Practice Recommendations

Eye Care

Refer people with diabetes for a comprehensive dilated retinal examination by an ophthalmologist or optometrist:

at diabetes diagnosis, and

annually, or more or less often, as recommended by the patient’s eye professional.

Retinal imaging may be used to screen and monitor for retinopathy; a comprehensive eye examination is still needed to screen for and evaluate other eye problems.

People with diabetes are at lifelong risk for eye and vision problems, including diabetic retinopathy, cataracts, glaucoma, age-related macular degeneration, and blindness. Good control of glucose and blood pressure helps to prevent onset and reduce progression of diabetic retinopathy. In addition, early detection, monitoring, and treatment of retinopathy are essential to reducing the risk of blindness.

A retinal examination (i.e., a dilated fundus examination by an eye care professional or retinal imaging with interpretation by a qualified, experienced reader) should be used to detect retinopathy. Although serious vision loss due to diabetes can nearly be eliminated through timely diagnosis and treatment, only about half of all AI/AN people with diabetes receive an annual retinal examination.

→ Note: Women with pregestational diabetes, who either are planning a pregnancy or have become pregnant, should have a comprehensive eye examination, and be counseled on the risk of development and/or progression of diabetic retinopathy. This examination should occur in the first trimester and should be followed throughout pregnancy and for one year postpartum.

→ Note: Women with true gestational diabetes (GDM), however, are at very low risk for developing diabetic retinopathy during pregnancy due to the limited exposure to increased blood glucose. Therefore, retinopathy screening is not indicated in GDM.

A telemedicine program for diagnosis and management of diabetic retinopathy operating in remote, rural AI/AN health sites. Retinal images obtained for patients at these sites are transmitted to a national reading center for validated interpretation. The IHS JVN program has been very effective in meeting the standard of care for diabetic retinopathy surveillance and bringing high-risk patients to timely treatment for the prevention of vision loss.

A cross-training guide to reinforce consistent diabetes messages across the four disciplines – pharmacy, podiatry, optometry, and dentistry (PPOD) -- and to promote a team approach to comprehensive diabetes care that encourages collaboration among all care providers.

A kit designed for community health workers and health promoters, which provides information and tools to help educate people about diabetic eye disease in small group settings. It contains a step-by-step module, a flipchart, DVD, and other resources. NIH Publication No. 10-7363. 2010.

Patient Education Materials

National Eye Institute.

Diabetic Retinopathy: What You Should Know.
NIH Publication No: 06-2171. 2003. This booklet is for people with diabetic retinopathy and their families and friends. It provides information about diabetic retinopathy and answers questions about the cause and symptoms of this progressive eye disease.